Spacer devices

The most common adverse effects from inhaled corticosteroids include oropharyngeal candidiasis and hoarse voice. These can be minimized by rinsing the mouth after use and by using a spacer device with metered-dose inhalers. Increased bruising and decreased bone density have also been reported the clinical importance of these effects remains uncertain.1,2,19... 

Systemic toxicity of inhaled corticosteroids is minimal with low to moderate inhaled doses, but the risk of systemic effects increases with high doses. Local adverse effects include dose-dependent oropharyngeal candidiasis and dys-phonia, which can be reduced by the use of a spacer device. The ability of spacer devices to enhance lung delivery is inconsistent and should not be relied on. 

Newman, S.P., Clark, A.R., Talaee, N., and Clarke, S.W., Pressurized aerosol deposition in the human lung with and without an open spacer device. Thorax, 44 706-710 (1989). Newman, S.P., Clark, A.R., Talaee, N., and Clarke, S.W., Lung deposition of 5 mg Intal from a pressurized metered dose inhaler assessed by radiotracer technique, Int. J. Pharm., 74 203-208 (1991). 

Geriatric Considerations - Summary Ensure that the older adult can adequately use the inhalation device. A spacer maybe beneficial in fhose unable fo coordinate device operation and inhalation. Spacer devices improve drug delivery to the lungs, therefore monitor closely as the patient may also experience increased systemic side effects with improved exposure to albuterol. Monitor cardiac status. 

Rinsing the mouth following INH and using a spacer device reduces common EENT adverse effects... 

The efficacy and safety of fluticasone 750 micrograms/ day and beclomethasone 1500 micrograms/day delivered by a spacer device have been compared in 30 asthmatic children in a 12-week, randomized, double-blind, crossover study (118). All of the children had persistent asthma requiring 1000-2000 micrograms/day of inhaled glucocorticoids before the trial. There was no significant... 

Traditionally, pulmonary deposition of MDIs has been in the range of 10-20% [38-40], An increase in pulmonary deposition efficiency of MDIs has been achieved with the use of spacer devices [41-46], Aerosol deposition in the human lung has also been optimized after administration from a microprocessor-controlled pressurized MDI [47, 48], Improvement of pulmonary deposition of up to 40%... 

L. Agertoft, and S. Pedersen, Influence of spacer device on drug delivery to young... 

S. P. Newman, J. Brown, K. P. Steed, S. J. Reader, and H. Kladders, Lung deposition of fenoterol and flunisolide delivered using a novel device for inhaled medicines Comparison of RESPIMAT with conventional metered-dose inhalers with and without spacer devices, Chest 113 951 (1998). 

In order to overcome these limitations, spacer devices can be used. These are essentially extension tubes which effectively increase the distance between the orifice and the patient s oropharynx. This allows for... 

Patients who have difficulty in coordination with inhalers can use a spacer device. These remove the need for coordination between actuation of a pressurised metered dose inhaler and inhalation. The spacer device reduces the velocity of the aerosol and subsequent impaction on the oropharynx. In addition, the device allows more time for evaporation of the propellant so that a larger proportion of the particles can be inhaled and deposited in the lungs. The size of the spacer is important, the larger spacers with a one-way valve (Nebuhaler, Volumatic) being most effective. Spacer devices are particularly useful for patients with poor inhalation technique, for children, for patients requiring higher doses, for nocturnal asthma, and for patients who have poor coordination. 

Steroids are best delivered via a spacer device. Use of a spacer helps with the following ... 

The spacer device should be washed on a weekly basis in warm soapy water. It must then be left to dry naturally. If wiped with a cloth, the static created will... 

Asmus, M. J., Liang, J., Coowanitwong, I., and Hochhaus, G. (2004), In vitro performance characteristics of valved holding chamber and spacer devices with a fluticasone metered-dose inhaler, Pharmacotherapy, 24,159-166. 

Newman, S. R, Millar, A. B., Lennard-Jones, T. R., Moren, F., and Clarke, S. W. (1984), Improvement of pressurised aerosol deposition with nebuhaler spacer device, Thorax, 39, 935-941. 

Hindle, M., and Chrystyn, H. (1994), Relative bioavailability of salbutamol to the lung following inhalation using metered dose inhalation methods and spacer devices, Thorax, 49,549-553. 

Smyth, H. D., Beck, V. P, Williams, D., and Hickey, A. J. (2004),The influence of formulation and spacer device on the in vitro performance of solution chlorofluorocarbon-free propellant-driven metered dose inhalers, AAPS PharmSciTech, 5, E7. 

Qll Spacer devices are often used for treating asthma when the patient is less than five years of age. Explain the function of a spacer. 

Spacer devices are useful to deliver drugs into the respiratory tract of young children with asthma. They reduce the deposition of bronchodilator drugs in the pharynx and require little coordination by the patient to deliver the required dose. 

To ensure optimal drug delivery, it is necessary to coordinate activation of the inhaler with inspiration and a final hold of breath. Many patients, especially the young and the elderly, find this very difficult and spacer devices are often used between the inhaler and lips these act as an aerosol reservoir and also reduce impaction of aerosol in the oropharynx. Topical deposition can cause local side effects in the mouth, particularly Candida with inhaled glucocorticoids a spacer abolishes this problem. 

Inhaled glucocorticoids are generally safe at low doses. Topical effects (oral Candida and hoarseness) are easily eliminated by using a spacer device and rinsing the mouth. High doses (> 1500 microgram... 

Metered dose inhaler has been the most popular aerosol delivery device for the treatment of respiratory diseases, which is attributable to its portability and simple operation. Although seemingly easy to use, the MDI is a sophisticated device in design. The drug(s) are suspended or dissolved in a liquefied propellant system, which may also contain excipients such as cosolvents or surfactants. The formulation is kept pressurized in a small canister, sealed with a metering valve. Upon actuation through an actuator, the valve opens and the metered dose is dispensed as an aerosol spray from the expansion and vaporization of the propellant under ambient pressure. The inhalers may be used alone or with spacer devices, the electrostatic issues of which are considered in a later section. The present discussion focuses on the inherent charging of particles produced from MDIs. 

Spacer devices, also known as holding chambers, are used with MDIs to overcome problems in coordinating inhalation with actuation, especially in children, and minimize oropharyngeal deposition of drug particles.Essentially, a spacer serves as a reservoir to hold the aerosol cloud for the patient to inhale through a one-way valve at a natural pace. 

Newman, S.P. Spacer devices for metered dose inhalers. Clin. Pharmacokinet. 2004, 43 (6), 349-360. 

Barry, P.W. O Callaghan, C. Poor output of salbutamol from a spacer device effect of spacer static charge and multiple actuations. Thorax 1994, 49, 402. 

Dewsbury, N.J. Kenyon, C.J. Newman, S.P. The effect of handling techniques on electrostatic charge on spacer devices a correlation with in vitro particle size analysis. Int. J. Pharm. 1996, 137, 261-264. 

O Callaghan, C. Lynch, J. Cant, M. Robertson, C. Improvement in sodium cromoglycate delivery from a spacer device by use of an antistatic lining, immediate inhalation, and avoiding multiple actuations of drug. Thorax 1993, 48, 603-606. 

The effects of static charge in spacer devices on glucocorti-costeroid aerosol deposition in asthmatic patients. Eur. 

Reducing electrostatic charge on spacer devices and bronchodilator response. Br. J. Clin. Pharmacol. 2000, 50, 75. 

In addition to the simple spacer devices that have been described, there are also much larger volume spacer devices (500-750 ml). These devices provide all the... 

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